Susilo's new government must focus on grassroots health<\/p>\n
Hananto Wiryo, Mataram, West Nusa Tenggara<\/p>\n
The Cabinet of president-elect Susilo Bambang Yudhoyono must
\nensure that in designing its health programs focuses on servicing
\nand reaching grassroots by truly optimizing existing health
\ninfrastructures, improving affordability and awareness of health
\nservices, and also eliminating malpractice.<\/p>\n
In order to optimize and maximize health services, there needs
\nto be an improvement in the quality of health centers, from the
\nsimplest level up to the hospital level.<\/p>\n
While new infrastructures are important, the upcoming health
\nminister must be someone who truly understands and is capable of
\noptimizing the supply and distribution of medicines to the
\nPuskesmas, or local health centers.<\/p>\n
The availability of basic health service through health
\ncenters is urgent, especially in rural areas. Remote areas should
\nnot be abandoned and only be reached through mobile health
\nservices.<\/p>\n
Aside from improving health infrastructure, the discipline and
\ndedication of health personnel must be improved as well. There is
\nan urgent need, and should receive priority within the first 100-
\ndays of Susilo's administration.<\/p>\n
Another point that needs to be solved immediately is to
\nimprove the affordability of health services. The cost of health
\ncare should be trimmed down further to utilize the health
\ninsurance network. This system would allow health services be
\nprovided to all segments of society. Such things as the
\nintensification of the service quality of PT Askes -- the
\nnational health insurance program -- as well as establishing a
\ncommunity insurance scheme are things that should be looked at in
\nthe immediate future.<\/p>\n
Additional funds acquired by the government from cuts in fuel
\nsubsidies, for example, goods channeled toward the urgent health
\nservice needs of the country. But, in order to do this, the
\ngovernment must first ensure that it has created a transparent
\nsystem in the use and allocation of these funds.<\/p>\n
If necessary, and if possible, through this money, community
\nhealth insurance for the poor should be free of charge by clearly
\nidentifying criteria of poverty.<\/p>\n
Another issue often overlooked, yet a potential problem in
\nIndonesia, is the growing concern over the number of malpractice
\ncases. It is an issue that has rarely been touched in the past,
\nand all but neglected by past governments. Unfortunately, there
\nis a tendency to keep things quiet especially if the victims are
\npoor. This only causes the incidence of malpractice to go from
\nbad to worse.<\/p>\n
To reduce costs and the incidence of malpractice, a better
\nregulatory framework should be put in place by making regulations
\non the matter clear. The health minister should set an example by
\nasserting a strict health code and direct hospitals and community
\nhealth centers to set up Protap, or Standard Service and
\nManagement Procedures. The Protap could be both national and
\nlocal levels established by respective health centers and
\nhospitals.<\/p>\n
For example, if a patient is diagnosed with typhus, it is
\ncommon practice for doctors to prescribe ampicillin (generic
\nantibiotics) and chloramphenicol. In fact, it is also common
\nknowledge among medical personnel that in most cases,
\nchloramphenicol, is sufficient.<\/p>\n
The additional prescription of ampicillin is often due to
\nurging and sponsorship of pharmaceutical companies. The setting
\nof a Standard Service Procedure could help prevent such residual
\nprescriptions.<\/p>\n
The aim of having Standard Service and Management Procedures
\nis to reduce the risk of malpractice. It will help cover the
\nrational limit of prescriptions given by a medical doctor. It
\nshould also include coverage of surgical procedures that are
\nclearly needed. This is to prevent occurrences, such as a general
\nanesthesia for such a simple surgical process for someone who has
\na five-centimeter elbow wound.<\/p>\n
If there is a general standard procedure, we can easily pursue
\nwho is responsible for making such decisions. It is, thus
\ndesirable that every health service institution should have and
\napply Protap.<\/p>\n
These standard procedures do not have to be complicated and
\nthe new health minister should be able to instruct local
\nofficials to draft them individually or collectively. If there is
\na hospital director who is unable to draft such procedures, then
\nthe simple fact is that he or she is not fit to run a hospital.<\/p>\n
The writer is head of pediatrics at Mataram General Hospital.
\nApart from being a lecturer at Mataram and Udayana Universities,
\nhe also serves as an expert staff on health affairs for the
\ngovernor of West Nusa Tenggara, and is a member of the Democratic
\nParty.<\/p>",
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